Camp Insurance Completed Activity Report

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Completed Activity Report

Enter the name of the program. Refer to the initial coverage request form submitted by your unit.
Enter the date (s) of the program. Refer to the initial coverage request form submitted by your unit.
The serial number was sent to the unit requester in an email from Risk Management called "Confirmation of Coverage".
Were any claims filed on behalf of program participants? *This question is required.
Contact Risk Management immediately at (208) 885-7177.
Sub Total Calculation
Premium Values
Premium Calculation
Calculate the program's total premium: *This question is required.
Calculate the program's total premium: *This question is required.ParticipantsParticipation DaysSubtotalPremiumTotal
Day or Classroom Risk Camps ($0.06/participant/day) *This question is required
Adventure Sport ($0.30/participant/day) *This question is required
Overnight Camps, Upward Bound, Talent Search, and TRIO ($0.30/participant/day) *This question is required
Sport Camps ($0.35/participant/day) *This question is required

Payment Instructions

You will need to complete a claim voucher payable to American Income Life to pay for your coverage.

In the claim voucher system, American Income's vendor code is AMEINC. Enter the policy number of 4913 and the serial number of your program for the invoice number and request that the numbers be printed on the check stub. (Example - 4913, 111).

The claim voucher supporting documentation is a copy of this worksheet. You will need to print this document before submitting it. Please send risk@uidaho.edu a copy of the claim voucher and the completed activity report.

If you are not a fiscal person who completes claim vouchers, print this worksheet before submitting it and then provide the copy to your unit fiscal personnel for payment processing.